CSHCN Services Program 2010 > Claims Filing, Third-Party Resources, and Reimbursement > Third-Party Resource (TPR)

5.2.9.2 Third-Party Liability for Claims Involving Accidents

DSHS contracts with TMHP to administer third-party liability cases. To ensure that the CSHCN Services Program is the payer of last resort, TMHP performs postpayment investigations of potential casualty and liability cases.

TMHP also identifies and recovers CSHCN Services Program expenditures in casualty cases involving CSHCN Services Program clients.

Investigations are a result of referrals from many sources, including attorneys, insurance companies, health-care providers, CSHCN Services Program clients, and state agencies.

Referrals should be submitted on the Tort Response Form to the following address:

TMHP Tort Department
PO Box 202948
Austin, TX, 78720-2948
Fax: 1-512-514-4225

TMHP releases CSHCN Services Program claims information when a Department of State Health Services Form to Release CSHCN Services Program Claims History is submitted. The form must be signed by the CSHCN Services Program client, parent, or guardian. Referrals are processed within ten business days.

Refer to: Appendix B, "Tort Response Form,"on page B-135.

Appendix B, "Department of State Health Services Form to Release CSHCN Services Program Claims History,"on page B-136.

An attorney or other person who represents a CSHCN Services Program client in a third-party claim or action for damages for personal injuries must send written notice of representation to the TMHP Tort department at the address listed above. The written notice must be submitted within 45 days of the date on which the attorney or representative undertakes representation of the CSHCN Services Program client or from the date on which a potential third party is identified.

The following information must be included:

•The CSHCN Services Program client's name, address, and identifying information

•The name and address of any third party or third-party health insurer against whom a third-party claim is, or may be, filed for injuries to the CSHCN Services Program client

•The name and address of any health-care provider that has asserted a claim for payment for medical services provided to the CSHCN Services Program client for which a third party may be liable for payment, whether or not the claim was submitted to, or paid by, TMHP

Providers should indicate when information is unknown when the initial notice is filed. Revisions must be submitted when the information becomes available.

If the attorney or representative requests claim information about the CSHCN Services Program client, an authorization form must be included as part of the notice and must be signed by the CSHCN Services Program client, parent, or guardian. The Department of State Health Services Form to Release CSHCN Services Program Claims History must be used.

DSHS must approve all trusts before any proceeds from a third party are placed into a trust.

For additional information, providers may contact the TMHP Tort Contact Center at 1-800-846-7307, which is available Monday through Friday, from 8 a.m. to 5 p.m., Central Time.